Clinical significance of electrocardiographic markers of myocardial damage prior to aortic valve replacement

[en] Background: Pre-operative myocardial fibrosis and remodeling impact on outcomes after aortic valve replacement (AVR). We aimed at investigating the prognostic impact of preoperative electrocardiographic (ECG) markers of left ventricular (LV) myocardial damage, i.e. bundle branch block (BBB) and ECG strain pattern after (surgical or transcatheter) AVR for severe aortic stenosis (AS). Methods: Between April 2008 and October 2017, we explored consecutive patients referred to our Heart Valve Clinic for first AVR for severe AS. Detailed pre-operative phenotyping and ECG analysis were performed. Patients were followed-up after AVR for major cardiac events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke. Results: BBB and ECG strain were respectively observed in 13.5 and 21% of the 1122 patients included. These ECG markers identified a subgroup of older patients, with higher NYHA class and more advanced myocardial disease as detected by echocardiography, i.e. higher LV mass and lower LV ejection fraction, global longitudinal strain and integrated backscatter, than patients without ECG strain or BBB. ME occurred in 212 (18.6%) patients during a mean follow-up of 4.4 ± 1.5 years with higher incidence in case of ECG strain or BBB (HR 1.56, 95%CI 1.13–2.14, p = 0.006; HR 1.47, 95%CI 1.02–2.13, p = 0.04 respectively). The prognostic value of ECG strain remained significant after adjustment for age, diabetes and pre-operative LVEF. Conclusions: Pre-operative ECG markers of myocardial damage identify a subgroup of AS patients at high risk of post-AVR cardiovascular complications irrespective of other prognostic factors and should help the multiparametric staging of cardiac damage to guide AVR. © 2020 Elsevier B.V.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Coisne, A.; CHU Lille, Department of Clinical Physiology and Echocardiography, France, Univ. Lille, U1011 - EGID, Lille, F-59000, France, Inserm, U1011, Lille, F-59000, France, Institut Pasteur de Lille, Lille, F-59000, France

Ninni, S.; Univ. Lille, U1011 - EGID, Lille, F-59000, France, Inserm, U1011, Lille, F-59000, France, Institut Pasteur de Lille, Lille, F-59000, France, CHU Lille, Department of Cardiovascular Medicine, France

Pontana, F.; Univ. Lille, U1011 - EGID, Lille, F-59000, France, Inserm, U1011, Lille, F-59000, France, Institut Pasteur de Lille, Lille, F-59000, France, CHU Lille, Department of Cardiovascular Radiology, France

Aghezzaf, S.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Janvier, F.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Mouton, S.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Ridon, H.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Ortmans, S.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Seunes, C.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

Wautier, M.; CHU Lille, Department of Clinical Physiology and Echocardiography, France

More authors (15 more)

Language :

English

Title :

Clinical significance of electrocardiographic markers of myocardial damage prior to aortic valve replacement

Publication date :

2020

Journal title :

International Journal of Cardiology

ISSN :

0167-5273

eISSN :

1874-1754

Publisher :

Elsevier Ireland Ltd

Volume :

307

Pages :

130-135

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 09 July 2020

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